Abstract 14943: Significance of Improvement of Advanced Heart Block in Response to Corticosteroid Therapy in Patients With Cardiac Sarcoidosis
Introduction: Advanced heart block (AHB) is one of the major manifestations in patients with cardiac sarcoidosis (CS) and is regarded as a prognostic factor of poor prognosis. Although it has been reported that AHB is improved in response to corticosteroid therapy in some cases, the significance of the improvement remains to be examined.
Methods and Result: We examined 68 consecutive patients with CS who admitted to Tohoku University Hospital from October 1998 to September 2014 (57±11 years-old, M/F 18/50, mean follow-up 5.5-year). CS was diagnosed based on the original guidelines for diagnosis of CS from the Japanese Ministry of Health and Welfare. Corticosteroid therapy was performed in all CS patients. Among the 68 patients, 29 (43%) had AHB at admission (AHB group). The AHB group tended to have higher BNP level as compared with those without AHB (no-AHB group) (358±92 vs 200±35 pg/ml, P=0.086), whereas there was no difference in left ventricular ejection fraction between the two groups (50.0±18.9 vs 51.0±14.6%, P=0.801). Kaplan-Meier estimate of freedom from heart failure hospitalization, but not that from all-cause death or VT/VF, showed that the AHB group had more events than the no-AHB group (log-rank P=0.032) (Figure A). Importantly, among the 20 AHB patients after excluding 9 patients with CRT therapy at admission, AHB was improved in 6 in response to corticosteroid therapy but was sustained in the remaining 14, where event-free survival was significantly better in the former than in the latter (log-rank P=0.014) (Figure B). Although BNP levels were comparable between the two groups at admission (242±52 vs. 213±74 pg/ml, P=0.761), there was a significantly greater improvement in the BNP levels in patients with improvement of AHB (125±26 vs 22±7 pg/ml, P=0.022).
Conclusions: These results indicate that improvement of AHB in response to corticosteroid therapy may be an important prognostic factor of better prognosis associated with improved cardiac function.
Author Disclosures: M. Segawa: None. K. Fukuda: None. M. Nakano: None. M. Kondo: None. M. Hirano: None. H. Shimokawa: None.
- © 2015 by American Heart Association, Inc.